I can't afford Isentress anymore... drop it? switch?

[blue1]

I've been on Truvada + darunavir/ritonavir + Isentress since July 2012 without any side effects and a dramatic decrease in VL (66000 down to 73 in 1 month) and jump in CD4.

I live in Australia but do not qualify for medicare here, so I have to buy the meds online.  The cost per pill is roughly:
Truvada = $2.60
Darunavir = $2.60 (300mg so I need 3 per day)
Ritonavir = $1.60
Isentress = $10.00 (I need 2 per day)

The strain of HIV I have has a potential partial resistance to Tenofovir (in the Truvada).

Buying everything online costs me about $950 per month.  If I were to drop Isentress from my regimen it would only be $333 per month.  So, as you can see the Isentress is very expensive and I just don't know if I can afford it.

But, can I afford NOT to take it???  That is the question I ask to you all.  I was told this combo is a little bit overkill anyway, so perhaps dropping Isentress would have no effect, especially if I'm already undetectable.  Truvada + daurunaivr/ritonavir could be sufficient even if I have potential partial resistance to tenofovir?

Or instead of just dropping Isentress, perhaps there is something I could replace it with that doesn't cost so much?

Thanks

[Miss Philicia]

"overkill" would be relative -- in an ordinary patient yes, but I will assume that your resistance profile leads your doctor to have you on one extra HIV med in addition to a standard HAART one. fyi, that's what my situation is and I'm on exactly the same combo that you have been put on.

At any rate you should be discussing this with your doctor, not people on the internet who don't have access to your most current geno/phenotype lab test.

[blue1]

Thanks for the reply   Yeah, I do discuss with my doctor as well..but doesn't hurt to ask around.  And some of the people on these forums have been around long enough to know just as much as many doctors. 

I gather information from every source and weight its validity according to the source

[leatherman]

do you not have access to insurance and co-pay assistance?

[Miss Philicia]

His older posts indicate he's a US citizen living/working in Australia, and one of the conditions for working there was that he have private insurance.

[newt]

An money, money, money...

Since it is possible the tenofovir in Truvada is doing nothing (revisiting your nuke mutations in your older post) and your viral load is too low for a phenotype test, you could consider dropping the tenofovir and the Isentress once your viral load is undetectable and use boosted darunavir + 3TC << 3TC is cheap and many generic versions available. The results from boosted darunavir monotherapy studies for people with suppressed viral load are very good, if still small-scale. Especially if this is a stop gap until you go home next year eh?

But yes, tis a good question, can you afford not to take Isentress? Another one is can you afford/do you want to take nevirapine instead?

- matt

[eric48]

More or less nevirapine (viramune) is ca. 1/3 of Isentress (by standard manufacturer list price)

Strangely enough hte OP might have to or want to use NVP because it is cheaper (and a generic is available in some countries and soon everywhere);

Me, if I could be allowed to it, I would have preferred Isentress to Viramune.
In socialized healthcare (at least here), if you can afford to pay for some drugs that gvt has restricted to second line regimen, you are simply not allowed to it.

It just make me so angry and envious that, in the free world, people can opt to pay for their own drugs and not having big gvt have a say so on meds choice.

I am not sure but I think that hte OP is aged 68 and may have started meds with a relatively low or medium- low nadir.

Under such circumstances, considering that a switch is not too risky but not without risk (even if it is a small one), I think the OP does not have hte luxury of a virological failure. Making the switch ca. 6 months after becoming UD should minimize the risk, IMHO, eventhough I can not offer a rationale for this.

Viramune may be a good option to discuss with doc , but I personnaly would be a bit more conservative about the timing for the switch

Hope this helps

Eric

[chgo2012]

if you American, sounds like what you should drop is your job. If working abroad doesn't pay enough even for your "life saving" meds, you have no business staying there or anywhere else that you can't take care of your health properly. At least in America you have some access.

When I think about the facility some other countries offer (i.e. Brasil)  I think seriously in drop everything and get the hell out of here.

[emeraldize]

His older posts indicate he's a US citizen living/working in Australia, and one of the conditions for working there was that he have private insurance.

If he (You Blue1) has insurance that covers some of the med costs, why not check into co-pay assistance available from Merck and Gilead and all the rest of the makers of his regimen's meds? I'm not aware of any that don't offer co-pay assistance if the person is eligible.

Thanks to BillyB, I've used this option for more than a year and it's saved a considerable amount of money.

[mikeyb39]

i know its a long flight, but is there anyway to get your meds 6 months at a time and fly back to the states to get your refills.  i could be missing the whole point here because i just skimmed the post.